Caregiver Wellness Workshops

Tuesday, October 4, 2016

Thanksgiving creates gratitude

which generates contentment

that causes peace.

Todd Stocker

Happy Thanksgiving, Everyone!

I'm writing this post early because I'm winging off to Prince George, in BC's Interior, in an hour or so, for the first of several Caring On Empty workshops and then returning, briefly, before going to Vancouver Island to spend the holidays with dear ones.

Most of you know of my love for poetry and, especially for blessings. So, here is my gift to you who care for so many at this holiday season. It's one of Jan Richardson's blessings and it goes like this:

You Who Bless
You
who are
yourselves
a blessing

who know
that to feed
the hungering
is to bless

and to give drink
to those who thirst
is to bless

who know
the blessing
in welcoming
the stranger

and giving clothes
to those
who have none

who know
to care
for the sick
is blessing

and blessing
to visit
the prisoner:

may the blessing
you have offered
now turn itself
toward you

to welcome
and to embrace you
at the feast
of the blessed

However you will spend the holiday weekend, may you be blessed in the way of ordinary things - by what you do (or don't do), whom you see and the natural beauty all around you.

Tuesday, September 27, 2016

Happy Autumn! And it's a busy one already with two workshops finished before the end of September. I hadn't actually realized how little I knew about the lives of funeral service professionals (medical examiners, mortuary technicians, funeral directors, embalmers, advance planners, crematory operators, cemetery operators and others) until I facilitated two Caring On Empty workshops for the wonderful folk of the BC Funeral Association this month.

Like many, I have to admit, I have occasionally endorsed stereotypes of money-hungry morticians out to bilk the public in their time of need and have participated in story-telling about crusty, unempathic, funeral personnel.

Now, I must say, my eyes are opened. I'm developing a deep respect for these professionals whose work involves constant exposure to loss, grief and trauma; who frequently work with insufficient resources; and who carry all the stresses of running either a 24/7 small family business or trying to provide empathic care within a large impersonal corporate structure focused on profit.

These death care professionals are rarely included in our lists of people at risk for compassion fatigue and yet their risk factorsare great indeed. In a 2014 survey of 57 respondents from multiple countries done by author and blogger, Katie Hamilton, funeral directors identified the following emotional impacts of their work:

- Daily encounters with multiple traumatic images, smells and stories that are difficult to dispel.

- The stress of dealing with the emotionally-charged dynamics of devastated family members who may resent paying for funeral services or who cannot afford those services.

- Coping with the physical impacts of sleep deprivation and undervalued self care.

- Exhaustion due to 24/7 availability to clients and families and the subsequent sacrifice of their own family life - and the tension between the two.

- Dealing with inherent family tensions while trying to run a family business.

- Working for a large firm whose values do not align with your own and the resulting lack of support.

- The stress of dealing with multiple external professionals - clergy, physicians, coroners, police. (This is an issue of time, administrative details, interpersonal stress, and having to repeat death details multiple times thus increasing trauma exposure.)

- The profound sadness of certain deaths - gruesome circumstances, infants, children, young people, suicides. And the expectation that "professionals" will not show their emotional responses.

- Being socially isolated from the general population by the nature of the vocation.

Other stressors noted by those in the field include a lack of debriefing opportunities after a bad death, personally knowing those you tend or recognizing that they are a friend of your spouse or child, gender bias within the profession (women are "too emotional" to hire or promote and are relegated to paperwork and tidying / "real men" don't show tender emotions), and having to keep clients' family secrets - such as the nature of a death - especially in a small community.

These risk factors can result in the familiar signs of compassion fatigue and accumulated grief - cynical sarcastic humour (as opposed to healthy black humour), irritability and impatience, chronic sadness, defensive cheerfulness and hyperactivity, chronic physical complaints, heavy drinking, loss of empathy and compassion, family breakdown and emotional disengagement from co-workers and the very people you're trying to help. Ultimately, many decide to leave a once-loved profession or go on to depression and, rarely, suicide.

Some resilience strategies discussed in the workshops this month included:

- Creating an ongoing resilience plan and meeting regularly with a self-care buddy to review your progress and gain encouragement.

- Advocating for, and using, a good Employee Assistance Program, separate from the workplace, that understands the nature of your responsibilities.

- Making use of new technologies to reduce your time at work and on call - pagers and smart phones, informative websites, a good answering service to screen calls, software programs for obituary placement and death certificate filing.

- Balancing your death focus with a life focus - gratitude journalling, outdoor activities, nourishing hobbies, regular downtime with your family and friends, vacation time where you're geographically away from your workplace.

- Focusing on the joy you can find in the work (Compassion Satisfaction)

- Healthy eating and regular aerobicexercise.

- Monitoring alcohol intake and noticing when you're using it and for what purpose.

- Intentionally building and maintaining a nurturing spiritual life.

- Creating a professional support network of 4 or 5 people who will be consistently warm, accepting and supportive when called upon.

- Avoiding re-traumatizing each other with competitive story-telling at conferences and other gatherings. (ie Leave out the gory details!).

Serving and supporting others through their worst and most tragic days is a rewarding, but not necessarily an easy occupation. So, next time you see one of your neighbourhood death care professionals, why not take a moment to shelve any stereotypes and give them a smile. I'm sure they'd appreciate the support.

Friday, September 2, 2016

I'm finally back from a longer-than-intended summer vacation after discovering that I had not only broken my left elbow in a fall at the beginning of the season, but I'd injured my right wrist and elbow as well. So that put pay to any long hours of keyboarding over the past few months. I'm in the harness again, though, with just an occasional twinge to remind me to be careful, ready for what is shaping up to be a very busy autumn.

Because I have so many workshops booked between now and Christmas and because I've promised my doctor not to lift large boxes of books, handouts etc for the next while, I won't be offering the usual community-based Caring On Empty and Enneagram workshops again until the Spring. (My sincerest apologies to anyone who was looking forward to attending this fall!) Please watch this space in January for the new Spring dates on Granville Island.

September is here and I don't know about you, but I LOVE the autumn. (Yes, I know, it's not officially autumn yet but it feels like it is today.) It's my favourite time of year - so full of brilliance, abundance, energy and colour. My energy rises just at the thought of it. Not everyone feels that way, though. One of my dearest friends says she goes into mourning at this time every year as she bids farewell to the bright, warm, lazy days of summer. For those of you who face the same struggle, and even for those who don't, I've compiled a list of inspiring quotations praising the fall. May they help to ease you into the a kinder gentler relationship with this, the third and, in my opinion, most beautiful season of the year. Enjoy!

Life starts all over again when it gets crisp in the fall. F Scott Fitzgerald

At no other time does the earth let itself be inhaled with one smell, the ripe earth; in a smell that is in no way inferior to the smell of the sea, bitter where it borders on taste, and more honeysweet where you feel it touching the first sounds. Rainer Maria Rilke

I'm so glad to live in the world where there are Octobers!L M Montgomery

Autumn carries more gold in its pocket than all the other seasons. Jim Bishop

The winds will blow their freshness into you, and the storms their energy, while your cares will drop away from you like the leaves of Autumn. John Muir

Autumn was her happiest season. There was an expectancy about its sounds and shapes: the distant thunk pomp of leather and young bodies on the practice field near her house made her think of bands and Coca-Colas, parched peanuts and the sight of people's breath in the air. There was even something to look forward to when school started - renewals of old feuds and friendships, weeks of learning again what one half forgot in the long summer. Harper Lee

The season for enjoying the fullness of life - partaking of the harvest, sharing the harvest with others, and reinvesting and saving portions of the harvest for yet another season of growth. Denis Waitley

Delicious autumn! My very soul is wedded to it, and if I were a bird I would fly about the earth seeking the successive autumns. George Elliot

Listen! The wind is rising, and the air is wild with leaves, we have had our summer evenings, now for October eves! Humbert Wolfe

Two sounds of autumn are unmistakable ... the hurrying rustle of crisp leaves blown along the street ...by a gusty wind, and the gabble of a flock of migrating geese. Hal Borland

The ripples wimple on the rills / Like sparkling little lasses. / The sunlight runs along the hills / And laughs among the grasses... / Why, it's the climax of the year, - / The highest time of living!- / Til naturally its bursting cheer / Just melts into thanksgiving. Paul Dunbar

Though I still grieve as beauty goes to ground, autumn reminds me to celebrate the primal power that is forever making all things new in me, in us, and in the natural world. Parker Palmer

Even if something is left undone, everyone must sit still and watch the leaves turn. Elizabeth Laurence

May the air be crisp, may the leaves be few, may the season of Autumn bring great bounty to you! Author Unknown

Today is not only the birthday of our beautiful country, but for me and thousands of others it's the first day of summer holidays. Sadly, this year I'm packing for the cottage with one wing in a sling after catching my feet in the edge of the bedspread as I changed the sheets. Now, having snapped the head off the radius bone in my forearm, the packing process is a little more complicated!

(Yes, I know. I could at least have broken it doing something exciting but I did paint quite a picture as I caught both feet in the spread, flew low across the room, too quickly to save myself, landed and skidded even further across the carpet and then rolled on my back with my legs in the air, stunned and winded.)

After several moments of trying to catch my breath and figure out what had happened, I got up and checked for damage and, realizing that most of my in-town support network were away, called a physician friend half way across the country and together we did an ortho exam on the phone and figured that I'd be black and blue in the morning but that nothing was seriously awry.

Roll on the next morning when I woke to discover that, despite icing, my left elbow was crooked, swollen and exquisitely painful and the closest I could get to touching my nose with my finger was a good foot away. And that led to the first of many uneasy decisions regarding whether and how to ask for help.

Why is asking for help such a big deal ...?? Well, if you're like me, you grew up in a family where independence, strength and self-sufficiency were the expectation and, thus, the norm. "Whining" was nipped in the bud, trying-it-yourself-before-asking-for-help was mandatory and feeling anything from uneasy vulnerability to outright shame accompanied even the most legitimate requests for assistance. Such experiences, encountered both at home and at school, would not have been unfamiliar to anyone growing up in the '50's and '60's in North America.

In her more recent book, Help Is Not a Four Letter Word, author and researcher, Peggy Collins, has published survey results to the question, What frightens us most about asking for help?. The top twelve fears are:

bothering other people

rejection / being told no

looking weak, inadequate, needy or just plain foolish

someone taking over / surrendering some of my power

owing other people and having to pay them back

things not being done the way I would like them to be done

relying on someone who doesn't come through

losing the reputation that I can do it all

not performing like I was raised

not asking in the right way

others seeing my mess

believing my needs are not important enough for others to meet

Perhaps a few of these sound familiar ...?

Ultimately, after this week's fall, I had to face the vulnerability of requesting help before getting almost anything done and I relearned something I learned years ago when people cried after being invited to help with my husband's care; people WANT to help. All they need is the invitation and our willingness to be in the receptive role.

It's a great lesson in humility to recognize and admit that we helpers also need help sometimes - a lesson that most of us need to learn again and again. Interdependence is the goal of healthy relationships, families, organizations, communities and nations. None of us can go it alone. We need each other and, as life coach Heather Plett says, (quoting Christina Baldwin in The Seven Whispers), -

"Ask for what you need and offer what you can." That's what creates the balance, the yin and yang of relationship. Even those who teach this need to be reminded to put it into practice.

So, great bouquets of gratitude to Ted who supported me in the first hour after the fall, my sister Sheila who drove me from pillar to post all week long as I saw medical professionals and prepared to fly to Ontario, my friend Cathy who - as always - empathized and made me laugh, Sandra who provided distraction and Healing Touch, Ginger who took me to the Market for coffee and mystery books, Linda who drove me to church and offered more, and Janet (my Enneagram "six-sister") who worried and planned for me so I could relax! Interdependence is what makes a healthy world go round and I'm so very grateful for that truth this week.

Tuesday, June 14, 2016

I've said here recently that I am becoming more and more interested in the intersection between trauma resilience and spirituality. I think there are a vast number of spiritual practices we can glean from various faith traditions to help us calm our bodies, access presence and peace, guide our lives and fuel our work with others. One such practice is an updated version of the Jesuit exercise of daily Examen.

The Examen of Consciousness is usually practiced at the end of the day. It is a review that contains a short reflection on the day, recalling events, noting feelings and being mindful of the presence of The Holy (however you understand that to be) in your everyday life. The process is basically encapsulated in the answers to two questions:

1. For what moment today am I most grateful?

2. For what moment today am I least grateful?

Variations on this theme, offered by Dennis Linn, Sheila Linn and Matthew Linn in Sleeping With Bread, are:

1. When did I give and receive the most love today?

When did I give and receive the least love today?

2. When did I feel most alive today?

When did I most feel life draining out of me?

3. When today did I have the greatest sense of belonging to myself, The Holy and the universe?

When did I feel the least sense of belonging?

4. When was I happiest today?

When was I saddest?

5. What was today's high point?

What was today's low point?

6. What did I feel good about today?

What was my greatest struggle today?

Practicing the Examen takes about ten minutes to half an hour each evening, depending on whether you share the answers to your questions with yourself, your partner, your family or a group of friends. The Linn's say that they have met with a group of close friends every Sunday afternoon for several years to do an Examen of the week together before sharing a meal. In this case, the Examen not only provides a way to be more reflective and mindful, it offers the opportunity to build a deeper and more intimate sense of community with close friends.

The Examen can also act as a guide to important life decisions. Paying close attention over time to what makes you feel alive and what drains your life force can help you to choose occupational paths, decide whether to deepen relationships, know how to spend your re-creational time and determine your direction for a new year.

So, whatever your faith tradition or the lack of it, I invite you to try the Examen for a week and see if it might be a spiritual tool you'd like to add to your resilience toolkit on an ongoing basis.

ps And for those of you who are interested in the practice of meditation, Sounds True is offering a 10 day online Meditation Summit, starting today, with free talks by some of the top Buddhist and Christian meditation leaders, some of whom you've seen mentioned here from time to time, including Reggie Ray, Tara Brach, Sharon Salzberg, Rick Hanson, James Findlay, Thich Nhat Hanh, Saki Santorelli, Jack Kornfield and Pema Chodron. You can listen to each talk for free for 24 hours after it takes place.

Thursday, May 26, 2016

Earlier this year, Carolyn Bennett, Minister of Indigenous and Northern Affairs, proposed an Indigenous Book Club Month for June and I wanted to give you a heads up that June is fast approaching (how is that possible??) and to make some suggestions for your book club or individual indigenous reading.

My own choice for this month is to reread Tracey Lindberg's wonderful book, Birdie, a Canada Reads shortlist winner and a book that has brought greater heart knowledge to my understanding of the long reaching effects of colonization and the residential school system. It seems from the reviews that people either love or are totally confused by this book. I am one of those who love it.

Seen through the lens of intergenerational trauma, posttraumatic stress and the power of women to both betray and hold caring space for each other's growing wholeness, Birdie's story is one of relationship - relationship with self, relationship with family and relationship with the wider world.

This, in many ways, is a book about care-giving, or the lack of it. The story line is that of Birdie, an obese, impoverished, abused young Cree woman, who journeys from northern Alberta to Gibsons, on the BC Sunshine Coast, consciously searching for Jesse, a character in her favourite TV show, The Beachcombers, while at the same time unconsciously on an inner journey searching for her own healing and wholeness. As she sinks into seeming dissociation from the present, she is cared for by her Auntie Val who is well, the memory of her mother Maggie who is not, and her cousin Skinny Freda and landlady and bakery boss Lola who are somewhere in between. Each has been wounded and has coped in her own way and each expresses her caring according to the degree of her wholeness.

The fluid chronology of the Birdie narrative, slipping seamlessly between present and past, while disturbing and confusing to some, made perfect sense to me as a trauma therapist. While described as characteristic of a vision quest, this meandering in and out of "reality" and "the present moment" is also the experience of one whose sense of time and continuity has been jangled by trauma's intrusive memories and disorienting flashbacks.

Birdie is a story of hope, healing and transformation and I highly recommend it, especially to those who can restrain their analytical minds and just go with an empathic response to another's experience.

Other books by indigenous writers, recommended by CBC, that you might like to consider are:

1. A Coyote Columbus Story by Thomas King

2. My Mother is Weird by Rachna Gilmore

3. Halfbreed, The Book of Jessica, and Stories of the Road Allowance People by Maria Campbell

Monday, May 16, 2016

Knitting may seem a strange topic for this time of year but I'm planning to take yarn and needles to the cottage to teach a friend how to knit this summer so it's on my mind this week.

My Mom taught me to spool knit when I was six and and then to do "real knitting" when I was eight. Some fifty years later, my two younger sisters and I sat in a row in the hallway outside a busy intensive care unit knitting steadily as our Mom lay dying within. We hadn't consulted each other about bringing our knitting to our hallway vigil but, on reflection, there couldn't have been a better way of dealing with our stress or holding space for our mother's end-of-life.

As much by example as anything, Mom taught us to use knitting as a means of mending wounded hearts and as a stress reliever (- though she would never have used those actual words because she belonged to a generation that didn't believe much in taking time to heal wounds or deal with stress. Life was hard and you just got on with it). If you had been mindful, though, you would have noticed that her knitting came out whenever things were tough at work, when she was worried about one of us kids, when financial resources were scarce or when my dad was having a mental health crisis or drinking too much.

These days, we know that the knitting Mom used intuitively to deal with stress is showing up positively in the research literature. Knitting has a positive impact on health and wellness and may be part of the solution in reducing compassion fatigue. Studies suggest that knitting decreases stress, creates new neural pathways and can have an antidepressant effect. It can also help alleviate ruminating, delay memory loss and may help slow the onset of Alzheimer Disease. Learning to knit and seeing a finished product can build self esteem. And knitting also offers opportunities for creativity and calms and soothes through repetitive motion and the tactile softness and colour of the yarns.

A small February 2016 study of The Impact of a Knitting Intervention on Compassion Fatigue in Oncology Nursesin the Clinical Journal of Oncology Nursingnoted that a knitting intervention, (learning to knit through the non-profit,Project Knitwell, and knitting squares with colleagues during break times), can provide the above positive effects as well as offering opportunities to debrief informally. Using the Pro-QOLbefore and after a knitting intervention showed a significantly positive change in burnout scores and trends toward significance with the secondary traumatic stress and compassion satisfaction scores. These improved scores applied particularly to younger nurses. It would be interesting to see the results with a larger cohort.

Community Workshops 2017

There will be no Community-Based Workshops on Granville Island this fall due to Jan's broken arm.

Please subscribe to the Mailing List below or watch this space in the New Year for Spring 2017 dates for:

1. Caring On Empty: Compassion Fatigue Resilience Workshop for Helping Professionals and the

2. A Beginners Enneagram Workshop.

Join the Mailing List

Keep informed of upcoming workshops and events.

Email Address

Compassion Fatigue, Chronic Sorrow & Resiliency Workshops

Jan Spilman, MEd, RCC

Hello and Welcome!

Hi! I'm Jan Spilman, the founder and principal of Caregiver Wellness Workshops, a Vancouver-based provider of workshops and retreats dedicated to the healing, refreshment and revitalization of people-who-help-people.

I am also a Pre-Qualified Consultant withHealth Shared Services BC which means that I am pre-qualified to present workshops in each of the BC Health Authorities.

After 10 years as an acute and critical care nurse, 19 years as a trauma and grief therapist in private practice, and 7 years as a family carepartner, caring for my husband until his death from heart failure in 2004, my passion is helping people-who-help-people to live well with the stress of their personal and professional care-giving.

Presentation Feedback

I think your presentation was fantastic, and this sentiment was shared by everyone I spoke to! I was most curious to hear feedback from the psychologist who works in my clinic, as this is more her area than mine and she thought you were absolutely stellar!

In fact, you were the one I appreciated most during the entire conference. Part of the great impact of your presentation is that you have the ripple effect of making us happier people and therefore better clinicians. (Rather than merely increasing our knowledge base in a specific area with the scientific part of the meeting.)

I think that your area is very much overlooked for all healthcare professionals, and an area that has huge impact on patient care!

I found myself (talking) about your lecture to one of the physicians I work with who commented that you would be great for our hospital wide rounds here and/or their physician wellness program. I did forward your contact information and hope that more people can benefit from your expertise!

I sincerely hope to be able to hear you speak again. You have a refreshing and real take on things.

Jenny Wichart, BScPharm, ACPR

Paediatric Nephrology & Transplant Pharmacist

Alberta Children's Hospital

Calgary, Alberta

2010 CST Conference Liaison

Jan developed several workshops for health care professionals and nonprofessionals. Evaluations werevery positive. They remarked on Jan's ability to connect with people on a deep level and to effect change in outlook and practice.

Adaire Leander, RN, MSN, CHPCNS

Former Advanced Practice Nurse

Fraser Health Hospice/Palliative Care Program

Burnaby, BC

Jan is an OUTSTANDING adult educator! The learners nod their heads in recognition and understanding.

Cindy Bouvet, MEd, RT

Coordinator - North Shore Caregiver Support Project

North Vancouver, BC

I attended the in-service you gave September 20th with the MS Society. The information and techniques you shared were wonderful and definitely made a profound impact on everyone I spoke with. I think the most important aspect was that the information is excellent to share with caregivers we interact with, but also a critical "pit stop" for us all to do some self reflection.

Sonja

MS Client Services Staff

Vancouver, BC

Terrific presentation - well timed for me! Thanks for tossing the lifesaver! I will recommend this workshop.

Healthcare Professional

Whitehorse, Yukon

Feeling inspired! I will take home so much from this day to use for a lifetime.

What is Compassion Fatigue?

CF is a serious but natural negative consequence of working with people who are suffering or traumatized.

It is a trauma response that causes symptoms of posttraumatic stress culminating in a helper's loss of capacity for, or interest in, being empathic or compassionate with others' suffering. It almost always coexists with burnout.

What is Burnout?

Burnout is the effect of our perceived workplace demands exceeding our perceived resources. It is experienced as deep and profound physical, mental, and emotional exhaustion; depersonalization of one's care recipients; and loss of a sense of personal accomplishment.

What is Chronic Sorrow?

Chronic Sorrow is the natural, yet often unrecognized or misdiagnosed, profound, pervasive, recurring and ongoing episodes of grief experienced by people with permanent impairments and those who love them.

Because the illness or disability lasts the lifetime of the person who is ill, so does the grief.

At the crux of chronic sorrow is the perceived discrepancy between how life is and how it "should or could have been." (Roos, 2002)

What is the Enneagram?

The Enneagram (pronounced ANY-a-gram) is a surprisingly accurate and dynamic system of nine fundamentally different personality types. Each type has different patterns of thinking, feeling and acting and a different unconscious motivation. Each person within a type sees the world and responds to it in similar ways.

The Enneagram differs from other personality typing systems like the Myers-Briggs in that it focuses on the motivation behind our behaviour rather than the behaviour itself. Rather than "putting people in a box", as some might assume, the Enneagram helps to free us from the "box" of our unexamined personalities.

By working with the Enneagram over time, we develop a deeper understanding of ourselves and others and learn alternatives to our own patterns of behaviour. We can break free from worn-out coping strategies, become more accepting of ourselves and others and begin to see life from a broader, more compassionate perspective.

The Enneagram is particularly useful to those seeking Compassion Fatigue resilience as it can help to identify our personality-based areas of emotional reactivity. And, when combined with appropriate self-regulation strategies, it offers an individualized pathway for returning to a state of calm.